Accuracy of early burn depth assessment by laser Doppler imaging on different days post burn.
BACKGROUND
Accurate diagnosis of burn depth is essential in selecting the most appropriate treatment. Early assessment of burn depth by clinical means only has been shown to be inaccurate, resulting in unnecessary operations or delay of grafting procedures. Laser Doppler imaging (LDI) was reported as an objective technique to determine the depth of a burn wound, but the accuracy on very early days post burn has never been investigated yet.


METHODS
In 40 patients with intermediate depth burns, we prospectively evaluated and compared the accuracy of the LDI measurements with the clinical assessments on days 0, 1, 3, 5, 8. Clinical evaluation of the depth of the burn was performed by two observers blinded to the LDI images. Accuracies were assessed by comparison with outcome: healing times longer than 21 days were considered to be equivalent to a biopsy finding of a deep dermal wound. Obviously superficial and full thickness wounds were excluded. LDI flux level was used for LDI prediction of outcome: less than 220PU to predict non-healing at day 21.


RESULTS
The accuracies of burn depth assessments on the day of burn and post burn days 0, 1, 3, 5 and 8 using LDI were 54%, 79.5%, 95%, 97% and 100% compared with clinical assessment accuracies of 40.6%, 61.5%, 52.5%, 71.4% and 100%, respectively. LDI accuracy was significantly higher than clinical accuracy on day 3 (p<0.001) and day 5 (p=0.005). Burn depth conversion was also considered. This is the first study to quantify the advantage of LDI scanning over clinical assessments during these important early after burn days.
Hoeksema
Henk
H
Department of Plastic Surgery, Gent University Hospital, De Pintelaan 185, Gent, Belgium. henk.hoeksema@ugent.be
Van de Sijpe
Karlien
K
Tondu
Thiery
T
Hamdi
Moustapha
M
Van Landuyt
Koenraad
K
Blondeel
Phillip
P
Monstrey
Stan
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000473:pathology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D017439:Cicatrix, Hypertrophic / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D007834:Lasers; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012867:Skin / Q000473:pathology*; D016038:Skin Transplantation / Q000379:methods; D013997:Time Factors; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult